Annals for Hospitalists - May 2022
Authors: Megan Mack, Matthew Luzum, David H. Wesorick
Journal: Annals of Internal Medicine (2022)

Web ExclusivesMay 2022Annals for Hospitalists - May 2022FREEMegan Mack, MD*, Matthew Luzum, MD* and David H. Wesorick, MDMegan Mack, MD*From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)Search for more papers by this author, Matthew Luzum, MD*From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)Search for more papers by this author and David H. Wesorick, MDFrom Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWHO202205170 SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Inpatient NotesCOVID-19, Hospital Medicine, and a Way Forward—Marisha Burden, MD, and Vineet Chopra, MD, MScAs we enter the third year of the COVID-19 pandemic, these hospitalist leaders reflect on what we've gained, what we've lost, and what we should do next.Highlights of Recent Articles From Annals of Internal MedicineThe Management of Substance Use Disorders: Synopsis of the 2021 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice GuidelineAnn Intern Med. 2022;175:720-731. Published 22 March 2022. doi:10.7326/M21-4011This article is a synopsis of the 2021 U.S. Department of Veterans Affairs and U.S. Department of Defense guidelines on the treatment of substance use disorders (SUD). The guideline provides recommendations on both medical and psychosocial/behavioral interventions for the whole spectrum of substance use disorders, including alcohol use disorder (AUD), alcohol withdrawal syndrome (AWS), and opioid use disorder (OUD).Key points for hospitalists include:Benzodiazepines are recommended as first-line treatment for AWS. However, alternative medications, such as carbamazepine, gabapentin, and valproic acid, are suggested, on the basis of weaker evidence, for the treatment of mild to moderate disease (especially for patients in whom the risk of benzodiazepines is elevated).First-line treatment of AUD includes a combination of psychosocial interventions and medication treatment. First-line medications include naltrexone and topiramate, with weaker evidence supporting the use of disulfiram or acamprosate. Gabapentin is recommended if first-line agents are contraindicated or ineffective. A detailed table compares and provides detailed information on all of the SUD medications.Buprenorphine and methadone are the first-line treatments for OUD, but there is insufficient evidence to recommend any psychosocial interventions. An editorialist suggests that medication treatment for OUD should be provided regardless of whether a psychosocial treatment is available or accepted by the patient.Risks for Anaphylaxis With Intravenous Iron Formulations: A Retrospective Cohort StudyAnn Intern Med. 2022;175:656-664. Published 29 March 2022. doi:10.7326/M21-4009This retrospective cohort study compared the risk for anaphylaxis of 5 intravenous (IV) iron formulations administered to older adults from 2013 to 2018. Among 167 925 patients receiving first-dose IV iron infusions, iron dextran was associated with the highest rate of anaphylaxis (adjusted incidence rates [IR] of 9.8 cases per 10 000), followed by ferumoxytol (IR of 4.0 cases per 10 000). Ferric gluconate, iron sucrose, and ferric carboxymaltose anaphylaxis rates were 1.5, 1.2, and 0.8 cases per 10 000, respectively.Key points for hospitalists include:This study demonstrates low rates of anaphylaxis with all IV iron products, with the highest odds for low-molecular-weight iron dextran and ferumoxytol. Of note, the rates of anaphylaxis were not appreciably changed by excluding the high-molecular-weight formulation of iron dextran.Anaphylactic reactions necessitating hospitalizations occurred only after iron dextran and ferumoxytol administration; iron dextran was the only IV iron product that increased the combined outcome of anaphylaxis and death.Association Between Socioeconomic Disadvantage and Decline in Function, Cognition, and Mental Health After Critical Illness Among Older Adults: A Cohort StudyAnn Intern Med. 2022;175:644-655. Published 8 March 2022. doi:10.7326/M21-3086This retrospective cohort study evaluated the association between socioeconomic disadvantage and post–intensive care unit (ICU) status (declines in function, cognition, and mental health) among older (age ≥65 years) patients using data from a series of surveys that were done over a 7-year period. Patients were considered socioeconomically disadvantaged if they were “dual-eligible” Medicare and Medicaid patients. The authors found that dual eligibility was associated with a 28% increase in disability after ICU hospitalization and a nearly 10-fold greater odds of transitioning to probable dementia. Dual eligibility was not associated with symptoms of depression or anxiety after ICU hospitalization.Key points for hospitalists include:This study demonstrates that dual-eligible (Medicare and Medicaid) patients have worse functional and cognitive declines after critical illness than less socially disadvantaged patients.The authors conclude that rehabilitation and recovery efforts after critical illness should be prioritized among low-income seniors and that additional research is needed to better understand these disparities.The authors note several limitations of the study, including its reliance on administrative data and the significant differences in the average time from critical illness to follow-up surveys in the 2 groups.Major Update 2: Remdesivir for Adults With COVID-19: A Living Systematic Review and Meta-analysis for the American College of Physicians Practice PointsAnn Intern Med. 2022;175:701-709. Published 1 March 2022. doi:10.7326/M21-4784Should Remdesivir Be Used for the Treatment of Patients With COVID-19? Rapid, Living Practice Points From the American College of Physicians (Version 2, Update Alert 3)Ann Intern Med. 2022;175:W55-W57. Published 1 March 2022. doi:10.7326/M21-4810These articles represent an updated, living review and the corresponding practice recommendations. For this update, 1 new randomized controlled trial (RCT) and 1 subanalysis of a previously included study were added to the evidence. However, the major conclusions, as summarize by the practice points below, did not change.Key points for hospitalists include:Clinicians should consider remdesivir for 5 days to treat hospitalized patients with COVID-19 who do not require invasive ventilation or extracorporeal membrane oxygenation (ECMO).Clinicians should consider extending the use of remdesivir to 10 days to treat hospitalized patients with COVID-19 who develop the need for invasive ventilation or ECMO within a 5-day course.Avoid initiating remdesivir to treat hospitalized patients with COVID-19 who are already receiving invasive ventilation or ECMO.The Latest Highlights From Journal ClubDoes high-flow oxygen improve COVID-19 outcomes compared with conventional oxygen therapy?In severe COVID-19, high-flow vs. conventional oxygen therapy reduced intubation and time to clinical recovery at 28 dAnn Intern Med. 2022;175:JC38. doi:10.7326/J22-0011This RCT compared patients with known or suspected COVID-19 and acute hypoxic respiratory failure receiving either high-flow or conventional oxygen therapy and found that patients treated with high-flow oxygen therapy had lower intubation rates and quicker clinical recovery.Are midline catheters safer than peripherally inserted central catheters (PICCs)?PICC vs. midline catheter use for short-term indications was linked to major complications at ≤30 dAnn Intern Med. 2022;175:JC47. doi:10.7326/J22-0015In this cohort study, 10 863 adult patients received a PICC or midline catheter because of difficult venous access or the need for IV antibiotic therapy (lasting ≤30 days). The PICCs were associated with higher rates of complications, including bloodstream infections and catheter occlusion, but possibly a lower risk for catheter-associated deep venous thrombosis.Sign up here to have Annals for Hospitalists delivered to your inbox each month. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)Disclosures:Authors have reported no disclosures of interest. Forms can be viewed at http://www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-3315.* The authors contributed equally to the article. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists Inpatient Notes - COVID-19, Hospital Medicine, and a Way Forward Marisha Burden and Vineet Chopra Metrics May 2022Volume 175, Issue 5Page: HO5 ePublished: 17 May 2022 Issue Published: May 2022 CopyrightCopyright © 2022 by American College of Physicians. All Rights Reserved.Loading ...